Digital Hospital Automates Drugs, Vital Signs

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Digital Hospital Automates Drugs, Vital Signs

Patients in a New York City hospital will now saunter through the halls free of the kudzu of cords and tubes linking them to machines that let doctors and nurses know how they're doing. Instead, electrodes attached to the skin take their vital signs and relay them to medical personnel via a hybrid wireless/wireline network.

The gadgetry that makes this possible is part of New York Hospital-Cornell Medical Center's rebirth in the digital age. Doctors and nurses will cut the ribbon on a new facility housing the latest in medical telepresence technology after three years of construction.

The 776-bed wing, which stretches over the Roosevelt Parkway at 68th Street, will include 1,000 hallway workstations, a vending-machine pharmacy, and pint-sized "telemetry transmitters" that monitor patients remotely, all with a massive data-sharing network to service it all. The center will become the model for the next era of telemedical care, offering the long-awaited streamlining of information exchange at the most critical moments under a doctor's care.

The biggest advance at the Center is an ambitious Clinical Information System Initiative that will allow doctors and nurses to monitor patients from anywhere in the hospital. Through this wide-ranging system, all the monitors and electronic medical charts can talk to each other.

For example, Hewlett-Packard's DeviceLink and Motorola's EMTeck technology allow bedside EKG machines and respirators to pipe information from each room into an expansive backbone network wired inside the building. Wireless "telemetry transmitters" monitor and transmit vital signs - heart rate and respiration - from electrodes on the skin but let patients walk around device-free and thus speed their recovery.

All these readings, combined with a patient history, medical records, progress notes, and nurses comments could be viewed on any of the 1,000 workstations anywhere in the hospital. "It's an automated medical record available instantaneously," says Fred Macri, New York Hospital's vice president of general services. "It's a whole new system of care, and it's just much more efficient."

From now on, the medical stuff will also enter their information directly into the network from the mobile workstations. "Those big packs of papers the doctor's carry in ER?" Macri says. "Our doctors won’t be doing that. We are trying to eliminate a lot of the mess of that."

Macri says the system also shortens the "anxiety time" for patients. In the new wing, X-rays are photographed digitally through Kodak's Picture Archiving and Computerized Storage system and sent across the packet-switching network to doctors - no hard copy is ever exchanged. Previously, the time required to have X-rays printed, examined, and delivered was measured in hours. With PACS, "we can measure the cycle time in minutes," Macri says.

One of the slowest steps in care, says Macri, is the distribution of pharmaceuticals. Doctors used to have to jump through multiple hoops to get medication because hospitals aren't authorized to administer it themselves. In a senselessly complicated process, doctors are forced to fax an order to a pharmacy, which then evaluates it and sends the approved form to a storage station where an escort delivers it to the hospital. Macri said the whole circuit takes hours, sometimes days.

But a new pharmaceutical cabinet called SURE - which operates like a "combination ATM/vending machine," says Macri - can dispense approved medication in minutes. The machine has more than 200 drawers with the top 200 pharmaceuticals, including penicillin, antibiotics - even controlled substances like morphine.

After a doctor orders the necessary drugs, SURE transmits the request to a pharmacy, clears the order, and then ships it immediately to the workstation nearest the patient. "Then the nurse walks up to the cabinet and SURE pops open the drawer with two doses of the medicine," describes Macri. "The whole thing takes 15 minutes."

But to arrive at this efficiency will take some getting used to. Several thousand doctors and nurses have been in retraining for months to serve the hospitals 45,000 prospective patients. With so much private information online and in every hallway, Macri says the hospital was determined to keep the records safeguarded.

"There's all kinds of password measures," he replies. "The records are not that accessible."

But real bottom line here, he emphasizes, is not just time-saving measures, but medical attention. "The technology enables us to reduce patient stays without reducing the quality of care," concludes Macri. "Our goal is to reduce the length of stay."